Factors Associated with Antiretroviral Therapy Adherence (ART-Ad) among HIV+ Women in the Miami-Dade County Health Department AIDS Drug Assistance Program (MDC-ADAP)

Nearly complete ART-ad is required for long-term suppression of HIV among HIV-infected persons on therapy. Data on self-reported ART-ad were gathered among 100 women enrolled in the MDC-ADAP in focus groups. Acceptable adherence was defined as ≥ 90% of pills taken as prescribed. Of 100 women, median age 47 years, low income status, mostly African-American/Black (AA-B) (84%), with low levels of education (90% high school or less) who were enrolled, 90 provided data for analysis. While 79% women reported acceptable ART-ad, among demographic variables, race and ethnicity were correlated with ART-ad. Lower ART-ad was correlated to AA-B race (p=0.03, exact) in univariate analyses. Higher levels of ART-ad was correlated to Hispanic ethnicity [OR 0.36, 95% CI 0.13-0.97] in multivariate analyses. Women with lower reported ART-ad had a longer since HIV diagnosis (p=0.03) and higher HIV-1 viral load (p=0.03). Among barriers to ART-ad, women with low ART-ad were more likely to report being too busy, away from home, forgetful, having toxic and physical side effects, and scheduling ART as barriers (p<0.01, all). In final models total score of barriers, time since HIV infection (25% increase per year), ethnicity (64% reduction among Hispanic women versus all others), and age (10% reduction in risk per each year older) were associated with low ART-ad. Targeted counseling to address practical/organizational barriers and ART “fatigue” may be helpful in increasing ART-ad. Study limitations include the relatively small sample size and an overrepresentation of AA-B race, which does not mirror the MDC-ADAP source population (67%).